Prevalence and Risk Factors for the Peripheral Neuropathy in Patients with Peripheral Arterial Occlusive Disease

The early diagnostic value of ankle-brachial index combined with feet electrochemical skin conductance for peripheral artery disease in type 2 diabetes

AIMS/INTRODUCTION

In this paper, we focused on exploring the diagnostic and predictive clinical utility of ankle-brachial index (ABI) in combination with feet electrochemical skin conductance (FESC) for peripheral artery disease (PAD) in Chinese patients with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Overall, 183 Chinese T2DM patients were enrolled in this study. The patients were classified into three groups: Group 1 comprised of uncomplicated type 2 diabetics (n = 36), Group 2 consisted of patients with diabetic peripheral neuropathy (n = 103) whereas Group 3 patients displayed peripheral artery disease (n = 44). All patients underwent Sudoscan test using a Sudoscan (Paris, France) and ABI assessment.

RESULTS

Multivariate logistic regression models revealed that FESC was an independent risk factor of developing PAD in patients with type 2 diabetes. The AUC for diagnostic, positive predictive and negative predictive value of ABI in combination with FESC for PAD were 0.907, 0.733 and 0.920, respectively. The specificity and sensitivity of ABI in combination with FESC for PAD were 0.914 and 0.750, respectively.

CONCLUSIONS

Ankle-brachial index in combination with FESC can accurately be used in early diagnosis of PAD.

Early arteriosclerosis and its risk factors in subjects with prediabetes and new-onset diabetes

BACKGROUND

We aimed to investigate early arteriosclerosis and its risk factors in populations with prediabetes and new-onset diabetes.

MATERIALS AND METHODS

A total of 148 participants who did not have diabetes mellitus were assigned to three groups through an oral glucose tolerance test: the normal glucose tolerance (NGT) group; the impaired glucose regulation, also known as prediabetes group and the new-onset type 2 diabetes mellitus group. The insulin resistance index was assessed using the homeostatic model assessment of insulin resistance (HOMA-IR). An ELISA was used to determine the level of fibroblast growth factor 21 (FGF21). An arteriosclerosis detector was used to measure the brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI). The baPWV, ABI, and FGF21 were used to assess early arteriosclerosis.

RESULTS

Significant differences in age, systolic blood pressure (SBP), fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), 2-h insulin (2hINS), and HOMA-IR were found between the NGT group and the prediabetes and new-onset diabetes groups. All of the above, except 2hINS, showed an increasing trend. Moreover, the FGF21 was higher in the new-onset diabetes group than in the NGT group. The baPWV was higher in the new-onset diabetes group than in the other two groups, but no significant difference was noted in the ABI. Age, SBP, diastolic blood pressure, FPG, 2hPG, and FGF21 were positively correlated with the baPWV. In addition, FPG, SBP, FGF21, and HOMA-IR were independent risk factors for the baPWV.

CONCLUSIONS

Patients with prediabetes and new-onset diabetes may have more significant early arteriosclerosis. The blood glucose level and insulin resistance index may be independent risk factors for early arteriosclerosis.

Leriche Syndrome Misdiagnosed as Complex Regional Pain Syndrome in a Patient with Neuropathic Pain Caused by a Chip Fracture: A Case Report

Introduction: Leriche syndrome is an aortoiliac occlusive disease caused by atherosclerotic occlusion. We report a case of Leriche syndrome with a fracture that was suspected as complex regional pain syndrome (CRPS), as the post-traumatic pain gradually worsened in the form of excruciating neuropathic pain. Case Report: A 52-year-old woman with a history of hypertension was referred to the Department of Pain Medicine from a local orthopedic clinic because of suspected CRPS for excruciating neuropathic pain for one month. She complained of gait dysfunction and severe pain in the right foot following an incident of trauma with the right first toe. The average pain intensity assessed using the visual analog scale (VAS) was 90 (0: no pain, 100: the worst pain imaginable), and the neuropathic pain was evident as a score of 6/10 on Douleur neuropathique 4. Allodynia, hyperalgesia, blue discoloration of the skin, asymmetric temperature change (1.38 °C), and edematous soft tissue changes were observed. Ultrasonography showed a chip fracture in the first distal phalanx of the right first toe. The diagnosis was most probably CRPS type I according to the Budapest research criteria for CRPS. However, multiple pain management techniques were insufficient in controlling the symptoms. A month and a half later, an ankle-brachial index score of less than 0.4 suggested severe peripheral artery disease. Computed tomography angiography showed total occlusion between the infrarenal abdominal aorta and the bilateral common iliac arteries. Therefore, she underwent aortic-bifemoral bypass surgery with a diagnosis of Leriche syndrome. Three months after the surgery, the average pain intensity was graded as 10 on the VAS (0–100), the color of the skin of the right first toe improved and no gait dysfunction was observed. Conclusion: A chip fracture in a region with insufficient blood flow could manifest as excruciating neuropathic pain in Leriche syndrome.

Decrease of peripheral resistance after intraoperative administration of iloprost in patients with and without type 2 diabetes mellitus and with peripheral arterial occlusive disease

BACKGROUND

In many cases, Ilomedin^® infusions are applied as part of a perioperative measure in patients with peripheral arterial occlusive disease because it makes a relevant vasodilatatory effect in patients with type 2 diabetes mellitus and with/without peripheral neuropathy.

AIMS

A prospective case-control study was performed to investigate the effect of prostanoids on peripheral resistance in patients with type 2 diabetes mellitus and patients without type 2 diabetes mellitus, as well as the role of peripheral neuropathy in patients undergoing arterial reconstruction.

METHODS

Sixty patients undergoing arterial reconstruction were enrolled. Sufficient data were collected on 38 patients. Prior to surgery, peripheral nerve conduction velocity was measured. Blood flow volume at the common femoral artery was assessed intraoperatively using a Doppler flowmeter at four time points: at baseline before arterial reconstruction (T0), after reconstruction (T1), after 5 (T2) and 10 min (T3) after intra-arterial application of 3000 ng of Ilomedin. Peripheral resistance units were calculated as a function of mean arterial pressure and flow volume using the following formula: peripheral resistance unit = mean arterial pressure (mm Hg) / flow volume (mL/min).

RESULTS

Ilomedin produced an immediate and significant drop of peripheral resistance in patients without type 2 diabetes mellitus as well as in patients with type 2 diabetes mellitus. Patients with peripheral neuropathy showed a less pronounced effect to Ilomedin compared to individuals with normal nerve conduction velocity.

Improvement of peripheral microcirculation after cardioversion of atrial fibrillation

BACKGROUND

Near-infrared spectroscopy (NIRS) is a noninvasive method to measure regional tissue oxygenation (rSO₂ ). In patients with atrial fibrillation (AF), cardiac output and endothelial function are altered. Peripheral tissue oxygenation may therefore be reduced. This study aims to describe the peripheral tissue oxygenation of the feet before and after synchronized electrical cardioversion (CV) of patients with AF using NIRS.

METHODS

Patients with AF undergoing CV were included and screened for peripheral arterial disease (PAD), diabetes mellitus (DM), and peripheral neuropathy (PN). NIRS was performed before and after CV under continuous ECG and monitoring of peripheral oxygen saturation. NIRS was registered on the dorsoplantar and plantar area of both feet. Capillary blood gas analysis was performed and left ventricular ejection fraction (LVEF) was determined.

RESULTS

Twelve patients (five women, seven men, age 70.8 ± 10.8 years) participated. None had history of PAD. DM was present in three (25%) patients. Two patients (16.7%) had PN. CV was successful in 11 patients. Overall, rSO₂ improved significantly in all patients after CV (P = .0003). Mean improvement was 7.17%. There were no significant changes in body temperature, ankle-brachial index, sO₂ , pO₂ , pCO₂ , pH, or lactate after CV. Heart rate was significantly lower (P < .0001) and LVEF significantly higher (P = .0123) after CV.

CONCLUSIONS

In patients with AF, peripheral tissue oxygen saturation improves significantly after successful CV. This suggests that patients with PAD may not only benefit from interventional or surgical improvement of arterial vascularization, but also from CV in case of AF.

microRNA-451 protects neurons against ischemia/reperfusion injury-induced cell death by targeting CELF2

OBJECTIVES

miRNAs are a family of non-coding RNAs that affect cell growth, migration and apoptosis. However, little is known on the behavior of miRNAs in neurons. Hence, this work aimed to investigate the functions and roles of miRNA-451 in neurons induced by ischemia/reperfusion injury.

MATERIALS AND METHODS

In this study, we established a 12- or 24-hour oxygen and glucose deprivation/reoxygenation (OGD/R) cell model. miR-451 mimic, si-CUGBP Elav-like family member 2 (siCELF2), oeCELF2 and the corresponding negative controls were transfected into the 24-hour OGD/R cells. The transfection efficiency and the relative expression of miR-451 and CELF2 were measured using quantitative reverse transcription PCR and Western blot analysis. Cell viability, apoptosis, oxidative stress and cleaved-caspase-3 expression were assessed using Cell Counting Kit-8, LDH, SOD, malondialdehyde, ROS assays, flow cytometry and Western blot analysis upon miR-451 overexpression, CELF2 silencing or overexpression of both. Bioinformatics analysis and the dual-luciferase reporter assay were used to examine the relationship between CELF2 and miR-451 in the OGD/R cells.

RESULTS

The results showed that miR-451 was downregulated in the OGD/R cells. The overexpression of miR-451 increased cell viability and SOD activity, but decreased apoptosis rate, levels of LDH, MDA, ROS and cleaved caspase-3 expression. CELF2 silencing inhibited apoptosis and oxidative stress. The results suggested that CELF2 was a target of miR-451, and that CELF2 overexpression alleviated the inhibitory effect of miR-451 on apoptosis and oxidative stress of the OGD/R cells.

CONCLUSION

The results demonstrated that miR-451 could protect cells against OGD/R-induced apoptosis and oxidative stress by targeting CELF2.

Waist Circumference and Subclinical Thyroid Dysfunction in a Large Cohort of Chinese Men and Women

OBJECTIVE

The association between subclinical thyroid dysfunction and waist circumference (WC) is still controversial, especially from the perspective of sex differences. We aimed to explore the impact of sex on this relationship in a large Chinese cohort.

METHODS

This cross-sectional study recruited 13,505 healthy participants (8,346 males, 5,159 females) who were enrolled in a health check program. Clinical data were collected. The association between subclinical thyroid dysfunction and WC of both sexes was analyzed separately after dividing WC into quartiles. Odds ratios (ORs) were calculated by binary logistic regression models, and linear regression analysis was also performed.

RESULTS

The prevalence rates of subclinical hyper-and hypothyroidism were significantly lower in males. Binary logistic regression models showed that WC in females with subclinical hypothyroidism had a detrimental effect with an OR of 1.011, but the effect disappeared when we included other covariates. The other ORs indicated no significant effects. The weak negative relationship between WC and thyrotropin was also indicated by linear regression analyses with very low R² values.

CONCLUSION

The current research did not show WC as a risk factor for subclinical thyroid dysfunction in either sex. Regional and ancestral origin differences may account for the variations with other studies.

ABBREVIATIONS

ALT = alanine aminotransferase; BMI = body mass index; FT3 = free triiodothyronine; FT4 = free thyroxine; TG = triglycerides; TSH = thyroid-stimulating hormone; UA = uric acid; WC = waist circumference.

The Proteolytic Fraction from Latex of Vasconcellea cundinamarcensis (P1G10) Enhances Wound Healing of Diabetic Foot Ulcers: A Double-Blind Randomized Pilot Study

INTRODUCTION

The aim of the study was to investigate the role of the proteolytic fraction from Vasconcellea cundinamarcensis, designated as P1G10, on the healing of chronic foot ulcers in neuropathic patients with diabetes 2.

METHODS

Fifty patients were enrolled in a prospective, randomized, double-blind trial, to verify the efficacy and safety of a topical dressing formulated with 0.1% P1G10, intended for wound healing, versus a hydrogel (control) protocol. Upon completion of the intervention, the outcome evaluated the number of patients attaining full epithelization (100%), or at least 80% healing. Statistical analysis compared the data on each group for the significance of the differences.

RESULTS

Collection of data was finished in week 16, and the results were analyzed by intention to treat. The results showed that, in the control group, 5 patients attained 100% ulcer healing, 3 patients ≥ 80% healing and 11 experienced ulcer changes ≤ 80%, and the remainder showed no changes or their wounds became worse. Meanwhile, in the P1G10 group, 11 patients experienced full healing, 4 had healing ≥ 80% and 5 had ulcer changes ≤ lower than 80%, and the remainder showed no changes or their wounds became worse. The healing incidence for the first endpoint (100% healing) showed that the P1G10 group was 2.95-fold more efficacious than the control group (CI 95%) and 2.52-fold (CI, 95%) higher than its control for the second endpoint (80% healing).

CONCLUSIONS

These data support the hypothesis that topical application of the proteolytic fraction identified as P1G10 significantly enhances foot ulcer healing compared to hydrogel treatment.

Glycated albumin indicates peripheral diabetic neuropathy

AIMS

We investigated associations between serum levels of glycated albumin (GA) and glycated hemoglobin (HbA1c) and the presence of diabetic peripheral neuropathy (DPN) in patients with type 1 diabetes mellitus (T1DM).

METHODS

Between September 2009 and April 2015, we evaluated 314 patients with T1DM in the Endocrinology Department of Shengjing Hospital of China Medical University. We divided the patients into the DPN group (n = 72) and the non-DPN group (n = 242), on the basis of the presence of DPN.

RESULTS

The DPN group had significantly higher GA values than the non-DPN group. After univariate logistic regression, we selected several factors for further analysis: HbA1c, GA, duration of T1DM, body mass index, smoking, hypertension, and the presence of diabetic complications, including nephropathy, retinopathy, and cardiovascular disease. We performed a multivariate logistic regression analysis to examine the association between the presence of DPN and each of these variables. We identified GA, HbA1c, hypertension, smoking, retinopathy, and cardiovascular disease as independent variables for indicating the presence of DPN. Results of a receiver operating characteristic curve analysis revealed that the area under the curve of GA (0.771) was larger than that of HbA1c (0.629). We defined the cutoff value of GA as 23.5 % (sensitivity 0.764, specificity 0.661) and the cutoff value of HbA1c as 8.45 % (sensitivity 0.667, specificity 0.595) for predicting DPN in patients with T1DM.

CONCLUSIONS

GA may be a better indicative marker of DPN in patients with T1DM than HbA1c.